clinical nerve examination of hands and upper limb

1. Nerve examination (clinical)
STUDENT, DR. RKGMC HAMIRPUR

2. Sensation – two point discrimination test
Two-point discrimination measures the individual’s ability to perceive
two points of stimuli presented simultaneously.
Motor –
• radial nerve: test thumb IP joint extension against resistance.
• median nerve
• recurrent motor branch: palmar abduction of thumb
• anterior interosseous branch: flexion of thumb IP and index DIP joints.
• ulnar nerve: cross-fingers or abduct fingers against resistance

3. Nerve assessment
•Tinel’s test
•tests for carpal tunnel syndrome
•examiner percusses with two fingers over distal palmar
crease in the midline
•positive if patient reports paresthesia in median nerve
distribution
•Phalen’s test
•tests for carpal tunnel syndrome
•with the hands pointed up, the patient's wrist is allowed
to flex by gravity in palmar flexion for 2 minutes
maximum
•positive if patient reports paresthesia in median nerve
distribution

4. •Froment's sign
•tests for ulnar nerve motor weakness
•patient asked to hold a piece of paper between thumb
and radial side of index
•positive if as the paper is pulled away by the examiner the
patient flexes the thumb IP joint in an attempt to hold on to
paper
•Wartenberg's sign
•tests ulnar nerve motor weakness
•patient asked to hold fingers fully adducted with MCP, PIP,
and DIP joints fully extended
•positive if small finger drifts away from others into
abduction
•Jeanne's sign
•tests for ulnar nerve motor weakness
•ask patient to demonsntrate key pinch
•positive finding if patients first MCP joint is hyperextended